| NPI | 1700406634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: TX 761891) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: WA 60961888) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2020-04-21 |